Why Has Service Integration Been So Elusive - Essay Example

 Human Service Integration Introduction The need for public human service agencies to integrate services is well established. A large number of human service agencies be aware of that in order to achieve positive results for vulnerable families and children, they must focus holistically on the customer. We know that a lot of customers come to the door of human services with a difficult set of needs that no one program service area can fulfill on its own. Simultaneously, we also know that each program area has its own viewpoint, goals, service arrangement, and terminology that are challenging issues to overcome when integrating services. Funding streams and federal mandates contribute to the confront of integrating services by pulling a human service agency in diverse directions. As a result, "Ms. Jones" walks into a human service agency office a whole person and the system virtually breaks her and her family into pieces in order to serve her, consistent with the structure of most human service programs. (Reitman, 2005) Despite and perhaps because of these challenges, we know human service agencies can no longer afford not to integrate services. The lives of children and families literally rely on the extent to which human service agencies integrate services for better performance. Challenges of Service Integration Although service integration is well established in theory, making it an operational reality has remained elusive over the last 20 years, but not for lack of effort or creativity some agencies have made phenomenal progress toward service integration, despite complex and ever-changing political, economic, demographic, and technological conditions. One-stop shops have emerged, joint planning has been initiated, co-location of two or more service agency's staff has been implemented, standard initial screening tools and eligibility processes have been established, and the merging of data systems is ongoing in many jurisdictions. While there have been successful pilot programs over the years, there have been few broadly implemented system changes that have brought service integration pilot programs "to scale." Historically, pilot programs and studies of best practices have not been widely replicated, not because they were "bad" strategies, but rather a critical component was missing: high-performance leadership. (Atkinson, 1999) Although we traditionally associate "leadership" with the work of the chief executive, the missing component in successfully integrating services is leadership work performed throughout the agency. An agency with sufficient leadership capacity to integrate services is made up of employees who all perform components of leadership work, management work, task/technical work, and team skills. (McLennan, Caza, 2003) Why Has Service Integration Been So Elusive? We know why we need to integrate services, we know what we've learned from our successes and failures, and we know that we must build leadership capacity throughout the organization. Why, then, have we been unable to make service integration a reality? In a nutshell, we are trying to get integrated performance from a hierarchical system that was designed for standardized production. There is no "standard" customer; each needs different things in different combinations at different times for different reasons. Nor are we doing production work. The hierarchical organizations we work in were designed 100 years ago for standardized production under drastically different economic, technological, social, and political conditions. The rate of change during that time was relatively slow. Service integration has been elusive because it requires that we create flexible, performance-based, integrated organizations despite our hierarchical history and structure. In a survey of APHSA members, today however, 86 percent of the respondents said they envision their agencies integrating or consolidating its services in the future. Creating an Integrated, High-Performing Organization Creating an integrated, high-performing organization requires specific leadership work at all levels of the organization. APHSA's Leadership for High Performance (LHP) model defines this work in concrete and practical terms. The model is based on 50 years of applied organizational research and has been field tested in many state and local human service agencies across the country. ((McLennan, Caza, 2003)) The LHP model defines leadership work simply as creating and sustaining high performance and includes three leadership functions with related tasks and a set of competencies, all of which are defined, observable, and measurable. Because the model provides a concrete "list" of leadership functions and related tasks, it serves as a roadmap to high performance. The leadership functions that must be performed at all levels of the organization are: Setting Direction, Setting Boundaries, and Creating Alignment. It is important to note that high performance occurs when we are attending to all three leadership functions. (Provan, Milward, 2004) Setting Direction Setting direction involves a set of tasks that clearly define what business we are in, who we serve and what they need, and how we will know if we have served them successfully. Again, this work is done in varying degrees by everyone in the organization. One of the most critical tasks in this function is developing a clear vision and mission. We've all heard of how important vision and mission are to organizations but experience has proven them to be more catchy than useful. Although we often trivialize "vision" by tending to it as if it were a dreaded task to complete and then relegating it to its place on a forgotten laminated card, we must have a vision that literally guides everything we do. If we are to truly integrate services, we must all sing from the same sheet of music, particularly since we each have different contributions to make to the song. Effective visions are: Simply stated and convey passion for the work. A vision energizes and focuses many parts of the system in a common direction, and it must be easily understood. For example, "Every child has a right to a childhood," "Families work," "Children in our community are safe," or "We won't have a nursing home we wouldn't put our mothers in!" are simple statements that energize staff better than "We will provide services timely and accurately." Broad enough to allow for multiple internal and external entities to "nest" beneath. An effective vision is a direction that everyone who must work together to holistically serve the customer (the core of service integration) can contribute to, no matter what "program" or support function they represent or whether they are even employed by the agency. For example, more "partners can contribute to "keeping kids safe" than to "meeting home visit requirements." (Morrison, 1996, p 127) Used to guide strategies and decisions. A vision that is not used to guide strategies and decisions is only a slogan. Key decisions should be considered and justified in relation to the vision. For example, if "keeping children in our community safe" is the business we are in, it will drive decisions about who we partner with and how we hold them accountable for keeping children safe, what policies we establish, what we measure, where we locate our service staff, what hours we establish, and what technology we use. Anchored by outcome-based performance indicators. A vision is only effective in setting direction if it is anchored by performance measures that answer the question, "Are our customers any better off for having come to us?" For example, if keeping children safe is the business we are in, how will we know if we are doing so? We have used process measures (largely due to federal reporting requirements), but knowing how many home visits your agency has conducted, for example, does not tell you whether your customers (children) are any safer. With these factors in mind, begin refraining what you communicate about your vision from language that conveys "compliance with policy" to language that conveys a higher purpose. Finding the "higher purpose" will allow you to engage your staff, integrated teams, and external partners to find common interests, goals, and collaborative strategies. Successful service integration depends on it. (Longoria, 2003) Setting Boundaries Setting boundaries involves tasks that establish how we will operate and treat each other. The tasks establish explicit boundaries for behavior, operations, and decision-making, such that the agency continuously learns and is able to respond to constantly changing conditions. Service integration requires that communication flows freely, teams are used, decision-making is dispersed throughout the system, goals are jointly established, and team members have a personal sense of efficacy. While public human service agencies have begun to exhibit some of these characteristics, such an open-system approach to work has not been widely or strongly embedded to the extent that is needed for successful service integration. (Helling, 1998) It is important to note that open, high-performing systems are not without boundaries. In fact, establishing boundaries around what is "in bounds" and "out of bounds" is even more important in an integrated system than in a divided, "stovepipe" system. In an integrated system there are more people doing more things, requiring more decisions, in uncertain and rapidly changing conditions. Since it is neither possible nor useful to "regulate" or micromanage such a dynamic process, broad but clear boundaries for operation must be established. Boundaries must be broad enough to facilitate the increased autonomy that is needed for such dynamic, knowledge-based work and they must be clear enough to facilitate increased accountability. (Agranoff, 1991) With these issues in mind, you can engage staff, existing partners, and potentially integrated service staff in identifying boundaries by discussing answers to the following questions: How will we treat our customers? How will we treat each other? What is appropriate behavior and what is not? How will we set goals for ourselves? What kinds of decisions can be made at the individual or integrated team level and which ones must be made at a higher level? How much budgetary authority resides at the individual or integrated team level? What are the roles and responsibilities of each person on the team? What is our protocol if someone goes "Out of bounds"? Creating Alignment Perhaps the most visible, labor-intensive, action-oriented leadership function is creating alignment. It is also the most critical to successful service integration because as changes in the way we do work are made, various organizational components must be realigned to support the changes. Creating alignment tasks involve aligning organizational support functions such as human resources, procurement, budget, and information technology, with the new way of doing business (the direction and boundaries of the organization). These tasks also involve aligning work processes and communication strategies to achieve more easily the vision. When any of these components are misaligned, the system spends enormous amounts of energy fighting itself. With limited energy available, it becomes crucial that the agency focus its energy on getting outcomes for customers, rather than on overcoming its own conflicts. Current support functions are, for the most part, designed to support the way work has been done in the traditional hierarchy and must be realigned to support the more open, dynamic, and interdependent work of integrated services. They must be redesigned from serving as control functions to serving as strategic support functions by directly supporting the fundamentally different work of integrated services. For example, human resources departments are designed to hire, evaluate, and reward for the skills and knowledge associated with specialized "program specific" work and are often focused on individual tasks. If we are serious about integrating services, we must hire, evaluate, and reward for a new set of team-based and leadership competencies. While technical skills and knowledge are still important, we must now add team and leadership competencies such as facilitation, negotiation, consensus building, systems thinking, and strategic thinking--skill areas that will result in high-performing, integrated services. (Hughes, Brindis, 1997) The same realignment is needed in the areas of budget, procurement, and information technology. For example, if we set prevention as one of our priorities, does our budget reflect that? Since service integration requires multidisciplinary service delivery, are budgets developed in multidisciplinary teams? Does our information technology support an integrated approach to service delivery? Does everyone have the information they need when they need it? (Glisson, Hemmelgarn, 2002, pg 418) Are our work processes helping or hindering our ability to produce customer outcomes? Since there is always something changing in our work, creating alignment is a continuous process. When we make a change to align one part of the system to better support integrated services, it will likely have an impact on other parts of the system, which will in turn need to be realigned as a result. It is an iterative process. Recommendations for developing alignment strategies include: Starting with the vision and boundaries you have established for service integration. At an upcoming staff meeting, systematically go through the human resources, procurement, budget, and information technology functions and ask, "What needs to change in this area to support our vision and boundaries?" As an alternative ask, "How is this support function a barrier to integrating services?" Engaging key staff from these supports functions as well as a cross-section of employees to discuss further the things you identified and to develop strategies for change. Requiring budgets to be developed jointly among the program directors who oversee the services that are to be integrated. Summary Service integration is the ultimate transformational change for public human services. It will become a broadly exhibited reality only when the leadership work is done at all levels. We will not wake up tomorrow morning to find that service integration has "happened." Service integration "gets done" in the day-today operations of the agency it gets done in an organization in which: All employees and stakeholders know why they are there and whom they are serving, Everyone involved is empowered and enabled to make decisions in the service of outcomes for clients, Everyone involved knows what is expected of them and is held accountable for it, and Service operations and support systems are aligned such that workers don't have to "fight" the system to get outcomes for clients. Creating human service agencies that fit this description relies upon our ability to build and sustain the capacity to do leadership work throughout our organizations. Unfortunately, leadership development has historically been done "in the margins" as an add-on to our already busy schedules. As we have learned in 20 years of attempting to integrate services, we cannot fundamentally change the way we do business in the margins. We must view leadership development as the critical component it is because leadership for high performance is the bottom line to making service integration a reality. References Amy Helling, Employer-Sponsored and Self-Sponsored Participation in Collaborative Visioning: Theory, Evidence, and Implications, Journal of Applied Behavioral Science, Georgia State University, Vol. 34 No 2, June (1998), pg 222-240 Charles Glisson and Anthony Hemmelgarn, The Effects of Organizational Climate and Interorganizational Coordination on the Quality and Outcomes of Children’s Service Systems, Child Abuse & Neglect Vol.22 No 5 pp401-421 Coordinated and Integrated Human Service Delivery Models, Social Policy Research Centre Dana Hughes, Claire Brindis, Neal Halfon, Paul W. Newacheck, Integrating Children’s Health Services: Evaluation of a National Demonstration Project, Mater and Child Health Journal, Vol.1, Nov.4, (1997) John D. McLennan & Michelle Caza, The Integration of Health and Social Services for Young Children and Their Families December 31st , (2003) Keith G. Provan, H.Brinton Milward, Do Networks Really Work? A Framework for Evaluating Public-Sector Organizational Networks, University of Arizona, (2004) Richard A. Longoria, Is Inter-Organizational Collaboration Always a Good Thing? University of Texas, Austin School of Social Work, (2003) Robert Agranoff, Human Service Integration: Past and Present Challenges in Public Administration, Public Administration Review, Indiana University, Nov/Dec (1991) Sue Ellen Atkinson, Collaboration: That Awful “C” Word, The Urban Review, Vol.3,N.2, (1999) Therese C. Reitman, Theories of Interorganizational Relations in the Human Services, University College of Southern Stockholm, (2005) Tony Morrison, Partnership and Collaboration: Rhetoric and Reality, Child Abuse & Neglect, Vol 20 No. 2 pp127-140 (1996) Read More